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Health system reform is considered a tough issue worldwide. Great efforts have been made toward health system building and strengthening. However, it is still unclear which health system is appropriate for different countries. This study aimed to systematically compare the characteristics of the establishment periods between eighty-eight counties of National Health Service (NHS) and Social Health Insurance (SHI).
Forty-eight NHS countries and forty SHI countries with data availability were selected. The establishment years of current health systems and other eighteen indicators in economics, society, population and health during establishment periods were collected. Comparison between NHS and SHI was conducted by descriptive analysis of every indicator.
Most NHS countries were established during the cold war, while SHI had been set up since the cold war ended. The median of gross domestic product (GDP) per capita, urbanization rate and aging rate of SHI were USD 1535 in current dollars, 58.2 percent and 9.8 percent, respectively; compared with USD 1387, 41.2 percent and 4.7 percent, respectively of NHS. NHS countries had a smaller total population, lower mortality rate and elderly dependency ratio, while the birth rate and children's dependency ratio were higher. SHI countries showed a higher life expectancy and lower mortality rate in infants and children. NHS countries spent less in total health expenditure and a lower proportion of GDP. The median health expenditure per capita of SHI and NHS were USD 188 and USD 131 in current dollars, respectively. There was little difference among maternal mortality rates, and public and private health expenditure proportions.
NHS and SHI countries had different characteristics during the health system establishment periods. NHS was established earlier than SHI overall, so that SHI revealed higher levels in economic and social development. Health outcomes of NHS countries were slightly lower than SHI ones, while health expenditure was more in SHI countries. Specific social, economic, demographic and health conditions should be considered when countries are building their own health systems.
Little is known about terrestrial climate dynamics in the Levant during the penultimate interglacial-glacial period. To decipher the palaeoclimatic history of the Marine Oxygen Isotope Stage (MIS) 6 glacial period, a well-dated stalagmite (~194 to ~154 ka) from Kanaan Cave on the Mediterranean coast in Lebanon was analyzed for its petrography, growth history, and stable isotope geochemistry. A resolved climate record has been recovered from this precisely U–Th dated speleothem, spanning the late MIS 7 and early MIS 6 at low resolution and the mid–MIS 6 at higher resolution. The stalagmite grew discontinuously from ~194 to ~163 ka. More consistent growth and higher growth rates between ~163 and ~154 ka are most probably linked to increased water recharge and thus more humid conditions. More distinct layering in the upper part of the speleothem suggests strong seasonality from ~163 ka to ~154 ka. Short-term oxygen and carbon isotope excursions were found between ~155 and ~163 ka. The inferred Kanaan Cave humid intervals during the mid–MIS 6 follow variations of pollen records in the Mediterranean basins and correlate well with the synthetic Greenland record and East Asian summer monsoon interstadial periods, indicating short warm/wet periods similar to the Dansgaard-Oeschger events during MIS 4–3 in the eastern Mediterranean region.
Northeastern (NE) India experiences extraordinarily pronounced seasonal climate, governed by the Indian summer monsoon (ISM). The vulnerability of this region to floods and droughts calls for detailed and highly resolved paleoclimate reconstructions to assess the recurrence rate and driving factors of ISM changes. We use stable oxygen and carbon isotope ratios (δ18O and δ13C) from stalagmite MAW-6 from Mawmluh Cave to infer climate and environmental conditions in NE India over the last deglaciation (16–6ka). We interpret stalagmite δ18O as reflecting ISM strength, whereas δ13C appears to be driven by local hydroclimate conditions. Pronounced shifts in ISM strength over the deglaciation are apparent from the δ18O record, similarly to other records from monsoonal Asia. The ISM is weaker during the late glacial (LG) period and the Younger Dryas, and stronger during the Bølling-Allerød and Holocene. Local conditions inferred from the δ13C record appear to have changed less substantially over time, possibly related to the masking effect of changing precipitation seasonality. Time series analysis of the δ18O record reveals more chaotic conditions during the late glacial and higher predictability during the Holocene, likely related to the strengthening of the seasonal recurrence of the ISM with the onset of the Holocene.
We examined the in vitro developmental competence of parthenogenetic activation (PA) oocytes activated by an electric pulse (EP) and treated with various concentrations of AZD5438 for 4 h. Treatment with 10 µM AZD5438 for 4 h significantly improved the blastocyst formation rate of PA oocytes in comparison with 0, 20, or 50 µM AZD5438 treatment (46.4% vs. 34.5%, 32.3%, and 24.0%, respectively; P < 0.05). The blastocyst formation rate was higher in the group treated with AZD5438 for 4 h than in the groups treated with AZD5438 for 2 or 6 h (42.8% vs. 38.6% and 37.2%, respectively; P > 0.05). Furthermore, 66.67% of blastocysts derived from these AZD5438-treated PA oocytes had a diploid karyotype. The blastocyst formation rate of PA and somatic cell nuclear transfer (SCNT) embryos was similar between oocytes activated by an EP and treated with 2 mM 6-dimethylaminopurine for 4 h and those activated by an EP and treated with 10 µM AZD5438 for 4 h (11.11% vs. 13.40%, P > 0.05). In addition, the level of maturation-promoting factor (MPF) was significantly decreased in oocytes activated by an EP and treated with 10 µM AZD5438 for 4 h. Finally, the mRNA expression levels of apoptosis-related genes (Bax and Bcl-2) and pluripotency-related genes (Oct4, Nanog, and Sox2) were checked by RT-PCR; however, there were no differences between the AZD5438-treated and non-treated control groups. Our results demonstrate that porcine oocyte activation via an EP in combination with AZD5438 treatment can lead to a high blastocyst formation rate in PA and SCNT experiments.
New speleothem records from northeastern Iberian caves provide data to explore the climatic patterns during the Holocene. We present δ13C and Mg/Ca from three speleothems from two different caves located in the Iberian Range allowing replication of the climatic signal for several millennia. Through the integration of those stalagmites covering since the Holocene onset to 2 ka, the early Holocene (11.7–8.5 ka) appears as the wettest interval. A marked change towards aridity is observed during the middle Holocene (8.5–4.8 ka) and an increase of humidity afterwards (4.8–2 ka). This three-part pattern, contrasting with other Iberian sequences, seems to be associated with the different role that seasonality has played in the response of different proxies (or records) to changes in water availability. Interpreting our speleothem records as changes in winter-spring precipitation along the Holocene allows reconciling previous data on hydrological variability from the western Mediterranean borderlands.
A stalagmite with high 238U content from Yangkou Cave, China, revealed the evolution of the Asian summer monsoon (ASM) between 49.1 and 59.5 ka, and the δ18O values recorded Dansgaard/Oeschger (D/O) events 13–17. The Yangkou record shows a relatively gradual transition into the D/O 14 and 16 events. The discrepancy between the abrupt and gradual transitions of D/O 14 in the records from northern and southern China, respectively, suggests different responses of the ASM to climate changes in the high northern latitudes. The higher resolution δ18O record and more precise 230Th dating indicate that the timing of D/O 14 and 17 in the Hulu records at 53 and 58 ka should be shifted to 54.3 and 59 ka, respectively. The gradual strengthening of the ASM at the onsets of D/O 16 and 14 in our record is different from the abrupt temperature rise in the northern high latitudes. Some other factors must contribute to this relatively gradual ASM change in southern China, but the actual reason is still unknown.
In this paper, an ultra-wideband (UWB) filter with a notch band using T-shaped step impedance resonator loaded with cross-shaped open stubs has been presented. The notch band is formed by utilizing intrinsic zero. The characteristics of the new quad-mode resonator have been analyzed using odd-even mode analysis method. It can be shown that it is the intrinsic zero that generates the notch band. In addition, wide tunable notch band form 5–9.3 GHz can be achieved. A UWB filter with a notch band centered at 6.25 GHz using the proposed quad-mode resonator has been designed, fabricated, and tested. Experiment results show that the attenuation in notch frequency is >22 dB while the return loss of the simulation and measurement results are 22 dB/20 dB and 14.5 dB/11.2 dB in the lower and upper passband, respectively, which illustrate that the simulation and measurement results are in agreement.
Archaeologists commonly use the onset of the construction of large burial monuments as a material indicator of a fundamental shift in authority in prehistoric human societies during the Holocene. High-quality direct evidence of this transition is rare. We report new interdisciplinary research at the archaeological site of Nan Madol that allows us to specify where and when people began to construct monumental architecture in the remote islands of the Pacific. Nan Madol is an ancient administrative and mortuary center and the former capital of the island of Pohnpei. It was constructed over 83 ha of lagoon with artificial islets and other architecture built using columnar basalt and coral. We employed geochemical sourcing of basalt used as architectural stone and high-precision uranium-thorium series dates (230Th/U) on coral from the tomb of the first chief of the entire island to identify the beginning of monument building at Nan Madol in AD 1180-1200. Over the next several centuries (AD 1300-1600) monument building began on other islands across Oceania. Future research should be aimed at resolving the causes of these social transformations through higher quality data on monument building.
We describe the performance of the Boolardy Engineering Test Array, the prototype for the Australian Square Kilometre Array Pathfinder telescope. Boolardy Engineering Test Array is the first aperture synthesis radio telescope to use phased array feed technology, giving it the ability to electronically form up to nine dual-polarisation beams. We report the methods developed for forming and measuring the beams, and the adaptations that have been made to the traditional calibration and imaging procedures in order to allow BETA to function as a multi-beam aperture synthesis telescope. We describe the commissioning of the instrument and present details of Boolardy Engineering Test Array’s performance: sensitivity, beam characteristics, polarimetric properties, and image quality. We summarise the astronomical science that it has produced and draw lessons from operating Boolardy Engineering Test Array that will be relevant to the commissioning and operation of the final Australian Square Kilometre Array Path telescope.
Deep-sea corals are a promising new archive of paleoclimate. Coupled radiocarbon and U-series dates allow 14C to be used as a tracer of ocean circulation rate in the same manner as it is used in the modern ocean. Diagenetic alteration of coral skeletons on the seafloor requires a thorough cleaning of contaminating phases of carbon. In addition, 10% of the coral must be chemically leached prior to dissolution to remove adsorbed modern CO2. A survey of modern samples from the full δ14C gradient in the deep ocean demonstrates that the coralline CaCO3 records the radiocarbon value of the dissolved inorganic carbon.
We present two isotopic (δ18O and δ13C) sequences of a twin-stalagmite from Zhuliuping Cave, southwestern China, with 230Th dates from 14.6 to 4.6 ka. The stalagmite δ18O record characterizes orbital- to decadal-scale variability of Asian summer monsoon (ASM) intensity, with the Holocene optimum period (HOP) between 9.8 and 6.8 ka BP which is reinforced by its co-varying δ13C data. The large multi-decadal scale amplitude of the cave δ18O indicates its high sensitivity to climate change. Four centennial-scale weak ASM events during the early Holocene are centered at 11.2, 10.8, 9.1 and 8.2 ka. They can be correlated to cold periods in the northern high latitudes, possibly resulting from rapid dynamics of atmospheric circulation associated with North Atlantic cooling. The 8.2 ka event has an amplitude more than two-thirds that of the Younger Dryas (YD), and is significantly stronger than other cave records in the Asia monsoon region, likely indicating a more severe dry climate condition at the cave site. At the end of the YD event, the δ13C record lags the δ18O record by 300–500 yr, suggesting a multi-centennial slow response of vegetation and soil processes to monsoon enhancement.
The paleoclimate application of speleothem δ13C is influenced by site-specific processes. Here we present four stalagmite δ13C records from two caves in southern China, covering early and late Marine Isotope Stage (MIS) 3 and the Holocene, to investigate the spatio-temporal pattern of calcite δ13C changes and the relationship with Asian monsoon (AM) variability. In each growth period, precessional- to millennial-scale changes are clear in the δ18O record. In contrast, millennial variability is absent in the δ13C record, which characterizes persistent centennial oscillations. However, centennial-scale δ18O variations agree well with those of δ13C, with a larger amplitude in δ13C changes (about twice that of δ18O). This suggests that soil humidity balance associated with regional hydrological circulations is important for these centennial δ13C changes, although evaporation-related kinetic fractionation can induce concurrent enrichments in δ18O and δ13C. In frequency, the detrended δ18O and δ13C records are coupled at a periodicity of about 300 yr during the last glacial period and 150 yr during the Holocene. Those centennial-scale δ13C variations are generally consistent with Greenland temperature variability, indicating a climate response over broad regions. Thus, strong co-variation of δ18O and δ13C records should have a climatic origin, even if it is amplified by kinetic effects.
We present a new record of radiocarbon ages measured by accelerator mass spectrometry (AMS) on a deep-sea core collected off the Pakistan Margin. The 14C ages measured on the planktonic foraminifera Globigerinoides ruber from core MD04-2876 define a high and stable sedimentation rate on the order of 50 cm/kyr over the last 50 kyr. The site is distant from the main upwelling zone of the western Arabian Sea where 14C reservoir age is large and may be variable. Many independent proxies based on elemental analyses, mineralogy, biomarkers, isotopic proxies, and foraminiferal abundances show abrupt changes correlative with Dansgaard-Oeschger and Heinrich events. It is now common knowledge that these climatic events also affected the Arabian Sea during the last glacial period through changes in the Indian monsoon and in ventilation at intermediate depths. The stratigraphic agreement between all proxies, from fine- to coarse-size fractions, indicates that the foraminiferal 14C ages are representative of the different sediment fractions.
To build a calendar age scale for core MD04-2876, we matched its climate record to the oxygen isotopic (δ18O) profile of Hulu Cave stalagmites that have been accurately dated by U-Th (Wang et al. 2001; Southon et al. 2012; Edwards et al., submitted). Both archives exhibit very similar signatures, even for century-long events linked to monsoonal variations. For comparison, we have also updated our previous work on core MD95-2042 from the Iberian Margin (Bard et al. 2004a,b,c), whose climate record has likewise been tuned to the high-resolution δ18O Hulu Cave profile. Sophisticated and novel statistical techniques were used to interpolate ages and calculate uncertainties between chronological tie-points (Heaton et al. 2013, this issue). The data from the Pakistan and Iberian margins compare well even if they come from distant sites characterized by different oceanic conditions. Collectively, the data also compare well with the IntCal09 curve, except for specific intervals around 16 cal kyr BP and from 28 to 31 cal kyr BP. During these intervals, the data indicate that 14C is somewhat older than indicated by the IntCal09 curve. Agreement between the data from both oceanic sites suggests that the discrepancy is not due to local changes of sea-surface 14C reservoir ages, but rather that the IntCal09 curve needed to be updated in these intervals as has been done in the framework of IntCal13 (Reimer et al. 2013a, this issue).
The IntCal09 and Marine09 radiocarbon calibration curves have been revised utilizing newly available and updated data sets from 14C measurements on tree rings, plant macrofossils, speleothems, corals, and foraminifera. The calibration curves were derived from the data using the random walk model (RWM) used to generate IntCal09 and Marine09, which has been revised to account for additional uncertainties and error structures. The new curves were ratified at the 21st International Radiocarbon conference in July 2012 and are available as Supplemental Material at www.radiocarbon.org. The database can be accessed at http://intcal.qub.ac.uk/intcal13/.
Introduction: The mortality of Parkinson’s disease (PD) and its associated risk factors among clinically definite PD patients in China has been rarely investigated. Our study aimed to identify the mortality rates and predictors of death in PD patients in China. Methods: 157 consecutive, clinically definite PD patients from the urban area of Shanghai were recruited from a central hospital based movement disorder clinic in 2006. All patients were regularly followed up at the clinic until December 31, 2011, or death. Mortality and associations with baseline demographics, health and medical factors were then determined within the cohort. Results: After 5 years, 11(7%) patients had died. The standardised mortality ratio was 0.62 (95% CI 0.32 to 1.07, P=0.104). The main causes of death were pneumonia (54.5%, 6/11) and digestive disorders (18.2%, 2/11), respectively. Age at onset, independent living, the mini mental state examination score, the Parkinson’s disease sleep scale score and the Epworth sleepiness scale score at baseline were statistically significantly different between the survival group and the deceased group (P<0.05). Across all participants, risk factors for death included low mini mental state examination score, and high Epworth sleepiness scale score according to a binary variable logistic regression analysis. Conclusions: This study confirms the similar survival of patients with PD to the control population up to a follow-up of 5 years. Interventions tailored to potential risk factors associated with death may offer further benefits.
In this study we report changes in Indian summer monsoon (ISM) intensity during the past ~ 3500 yr inferred from proxy indices at Lake Erhai, southwestern China. Both the pollen concentrations and other proxy indices, including sediment grain size, total organic carbon contents (TOC), and elemental contents (e.g., Fe, Al), clearly indicate a long term decreasing trend in ISM intensity over the late Holocene. During the period from approximately AD 750 to AD 1200, pollen concentrations of conifer and broadleaf trees, and herbs reached the lowest levels over the past ~ 3500 yr; while the pollen percentages of both herbs and broadleaf trees increased, suggesting a significant medieval drought. The grain size, TOC, and elemental contents also support an arid climate during the medieval period. The Little Ice Age (LIA) at Lake Erhai was characterized as cold and wet. The medieval and LIA climatic patterns at Lake Erhai were similar to those over most of the ISM areas, but anti-phase with those over East Asian summer monsoon (EASM) areas. We suspect that sea surface temperature variations in the Indo-Pacific oceans and the related land-sea thermal contrasts may be responsible for such hydroclimatic differences between EASM and ISM areas.
A high-resolution, annual layer-counted and 230Th-dated multi-proxy record is constructed from a stalagmite in Hulu Cave, China. These proxies, including δ18O, annual layer thickness (ALT), gray level (GL) and Sr/Ca, cover a time span of ~ 3000 yr from 21 to 24 ka. The physical proxies (ALT and GL) and the geochemical index (Sr/Ca), all primarily reflecting karst hydrological processes, vary in concert and their coherence is supported by wavelet analyses. Variations in the δ18O data agree with fluctuations in the ALT and Sr/Ca records on multi-decadal to centennial scales, suggesting that the Hulu δ18O signal is strongly associated with varying local rainfall amounts on short timescales. A monsoon failure event at ~ 22.2 ka correlates with a decrease in tropical rainfall, a reduction in global CH 4 and an ice-rafted event in the North Atlantic. This correlation highlights roles of the Asian monsoon and tropical hydrological cycle in modulating global CH 4, because the high-latitude emission was inhibited during the Last Glacial Maximum (LGM). Spectral analysis of the δ18O record displays peaks at periodicities of 139, 59, 53, 43, 30, 23 and 19"15 yr. The absence of typical centennial solar cycles may be related to muted changes in ocean circulation during the LGM.
We present a shoreline-based, millennial-scale record of lake-level changes spanning 12.8–2.3 ka for a large closed-basin lake system on the southwestern Tibetan Plateau. Fifty-three radiocarbon and eight U–Th series ages of tufa and beach cement provide age control on paleoshorelines ringing the basin, supplemented by nineteen ages from shell and aquatic plant material from natural exposures generally recording lake regressions. Our results show that paleo-Ngangla Ring Tso exceeded modern lake level (4727 m asl) continuously between ~ 12.8 and 2.3 ka. The lake was at its highstand 135 m (4862 m asl) above the modern lake from 10.3 ka to 8.6 ka. This is similar to other closed-basin lakes in western Tibet, and coincides with peak Northern Hemisphere summer insolation and peak Indian Summer Monsoon intensity. The lake experienced a series of millennial-scale oscillations centered on 11.5, 10.8, 8.3, 5.9 and 3.6 ka, consistent with weak monsoon events in proxy records of the Indian Summer Monsoon. It is unclear whether these events were forced by North Atlantic or Indian Ocean conditions, but based on the abrupt lake-level regressions recorded for Ngangla Ring Tso, they resulted in significant periodic reductions in rainfall over the western Tibetan Plateau throughout the Holocene.
Long-term fertilization experiment has been conducted since 1981 to study the effect of soil management practices on soil fertility, soil carbon and nitrogen sequestration, soil culturable microbe counts and crop yields at the Nanhu Experimental Station in the Hubei Academy of Agricultural Sciences (situated in the middle reach of the Yangtze River and the rice–wheat cropping system). The experiment was designed with the following eight treatments: (1) unfertilized treatment: Control; (2) inorganic nitrogen fertilizer treatment: N; (3) inorganic nitrogen plus inorganic phosphorus fertilizer treatment: NP; (4) inorganic nitrogen, inorganic phosphorus plus inorganic potassium fertilizer treatment: NPK; (5) pig dung compost (manure) treatment: M; (6) inorganic nitrogen fertilizer plus manure: NM; (7) inorganic nitrogen, inorganic phosphorus fertilizer plus manure treatment: NPM and (8) inorganic nitrogen, inorganic phosphorus, inorganic potassium fertilizer plus manure treatment: NPKM. The results showed that long-term application of organic manure in combination with inorganic fertilizer significantly (p < 0.05) increased soil organic C concentrations compared with the corresponding inorganic fertilizers alone. Soil organic C contents were significantly (p < 0.05) increased in balanced application of NPK fertilizers in comparison to unbalanced application of fertilizers. After 30 years of experiment, soil organic C and total N sequestration rate averagely were 0.48 t ha−1 year−1 and 28.3 kg ha−1 year−1 in the fertilized treatments respectively; nevertheless, it were 0.27 t ha−1 year−1 and 9.7 kg ha−1 year−1 in the unfertilized treatment. Application of organic fertilizer in combination with inorganic fertilizer significantly (p < 0.05) increased culturable microbial counts compared with the corresponding inorganic fertilizers alone. The balanced application of NPK fertilizers significantly (p < 0.05) increased culturable microbial counts compared with unbalanced application of fertilizers. The average grain yield of wheat and rice was significantly (p < 0.05) higher in organic manure combined with inorganic fertilizer treatment than in inorganic fertilizer alone and unfertilized control. Therefore, long-term application of organic manure combined with inorganic fertilizer and balanced application of NPK fertilizers could increase soil organic C and total N sequestration, culturable microbial counts and crop grain yields.
This paper describes the system architecture of a newly constructed radio telescope – the Boolardy engineering test array, which is a prototype of the Australian square kilometre array pathfinder telescope. Phased array feed technology is used to form multiple simultaneous beams per antenna, providing astronomers with unprecedented survey speed. The test array described here is a six-antenna interferometer, fitted with prototype signal processing hardware capable of forming at least nine dual-polarisation beams simultaneously, allowing several square degrees to be imaged in a single pointed observation. The main purpose of the test array is to develop beamforming and wide-field calibration methods for use with the full telescope, but it will also be capable of limited early science demonstrations.